Pulling the plug: India left to debate on legalization of euthanasia

The recent notice by the Supreme Court of India seeking the opinion of all states on whether to legalize passive euthanasia has stirred a debate amongst various sections of society.

In fact, the Union Minister for Health, Dr. Harsh Vardhan, said that euthanasia was a complex issue and opinions on it being made legal should be discussed before arriving at any consensus.

Stressing that there is no urgency, the health minister, who is a medical practitioner himself, said, "Law on euthanasia should not be formed till the society, government and related professionals develop a consensus is formed. It should not be hurried up. These are the issues which are not causing any impediment in our work."

Active euthanasia, which involves, the use of lethal substances on terminally ill patients, is illegal in India.

Though passive euthanasia - the withdrawal of life support devices - is allowed 'under exceptional circumstances', a court petition proposes a patient sign a will, enabling him legal rights to euthanasia, in case he suffers a terminal disease.

While many argue that humans do not have the right to take away a God-given life, there remain some, who see mercy killing as easing the misery of those who have no hope left.

Earlier this month, the Indian Society of Critical Care Medicine (ISCCM) filed a petition in the Supreme Court to be impleaded as a third party in the case.

Dr. R. K. Mani, ex-president of the IISCCM and chairman of pulmonary and critical care medicine at the Saket City Hospital, New Delhi, believes that the term euthanasia is very loosely used and has thus acquired wrong connotations. Dr Mani argues that it's rather 'end of life decisions'.

"We are talking about whether under certain circumstances, the patient has the right to choose not to have life support. It is not about injecting a substance. So we are talking about patient rights and what is normally done in most parts of the world," Dr Mani stresses.

According to the senior pulmonologist, terminally ill patients in most cases have no hope for a cure. "When patients have no hope for a cure, medical intervention becomes unduly burdensome or is against the wishes of the patient. His only way would then be to live on life support".

Doctors like him believe that imposing treatments on patients when there is no cure is actually prolonging a painful physical and mental trauma not only on the patient but a mental agony and financial burden on the family of the patient.

Procedures that involve life support systems range from anywhere between 40,000 -50,000 Indian rupees (USD 660-825 approx) a day, expensive treatments not many families can afford.

"We are nobody to impose on a patient, treatments which are of no use. The patient should be made aware of how effective or ineffective the treatment is that he has the freedom of choice. doctors are here to support the patient in a wise manner," said Dr. Mani.

Probably the most cited case in favour of active euthanasia would be that of Aruna Shanbaug who has been left partially brain dead, in a vegetative state since 1973 after she was sexually assaulted by a sweeper in the hospital where she was working as a nurse. The overriding memory of the assault is so strong that Aruna breaks into bouts of screams on hearing male voices.

A mercy killing petition was brought to court by her friend and journalist Pinki Virani after which the Supreme Court ruled passive euthanasia legal in March 2011.

Then there are those like Rajinder Johar who make for a strong case against legalizing euthanasia. Johar who was an occupational therapist, was left paralyzed neck-down after he was attacked by robbers at his home almost three decades ago.

From an ebullient young therapist to being dependent on others, Johar went into depression only to fight back. Today, from an orthopedic bed, he has given a fresh lease of life to thousands of disabled through his philanthropic mission, Family of Disabled (FOD).

The NGO assists the differently abled by motivating them and providing them employment opportunities along with equipment like wheelchairs. He believes that with a functioning mind and will power, even disabled people like him can make a difference to the world.

Little surprise then, Johar doesn't support the idea of euthanasia.

Johar says that the decision to put someone to sleep, is not an easy one. "The government has not yet declared that euthanasia is legalized but the debate is going on and we are prolonging if his life is miserable or if he is living in a very difficult situation. Are we doing right to prolong his miseries or should we bring an end to his miseries, the patient cannot tell, the person cannot tell. That is for the family and the experts to decide whether he should be put to sleep."

The debate is one that has left the Indian government cautious as varied opinions voice themselves on the sensitive issue.

Euthanasia is legal only in a few countries like Luxembourg, Belgium and the Netherlands. In other countries like Germany, Mexico and Switzerland euthanasia is legal but only in its passive form.

But in a country like India, where putting someone to sleep is not permissible in either religion or culture, will the idea of a law on euthanasia ever be accepted?